Summary of States Tools to Collect Data

Transcription

1 Summary of States Tools to Collect Data March 2015 Balancing Incentive Program States are required to collect three types of data: service data, quality data linked to population-specific outcomes, and outcomes measures. As part of their Work Plan deliverables, States must report to CMS the data and measures that will be collected and the methodology for collecting those measures. States will not be required to submit the collected data directly to CMS, though CMS does reserve the right to request these data at any time. If CMS requests data from a state, the state will have at least 30 days to submit the data. Services Data: Community long-term services and supports (LTSS) providers should report to the state all community LTSS services an individual receives at the individual level. Quality Data: Quality data include clinical measures that capture the extent to which service providers are supplying comprehensive, quality care. Most of these measures can be calculated with claims data or encounter data, which states should already be collecting from community LTSS providers. Once states calculate the measures based on the data submitted by providers, CMS strongly recommends that states report back measures to providers to encourage quality improvements. Outcomes : As a final data collection requirement, states should collect outcomes measures by population to assess beneficiary and family caregiver experience and satisfaction with providers. Data should also be collected regarding activities that help individuals achieve higher quality of life, including employment, participation in community life, health stability, and prevention of loss in function. The tables below describe state data collection instruments, as presented in Work Plans and updated in quarterly progress reports. For more information, please see Work Plans posted on Medicaid.gov: Information/By-Topics/Long-Term-Services-and-Supports/Balancing/Balancing-Incentive- Program.html. 1

2 Services Data State Claims data Encounter data* Other Use of data for administrative, financial or quality control purposes AR CMS 372 Form Reports: participants and expenditures to ensure cost neutrality Arkansas Prevention Needs Assessment: conducted on a representative sample of school aged children CMS 64 Form Reports Participant Claims History Profile: compares payment to plan of care CT CMS 372 Form and Specialized MMIS Reports GA LTSS expenditure detail: track participation and expenditures IA ADRC Track expenditures Compare encounter data across individuals Compare claims data across regions and Aging and Disabilities Resource Centers (ADRCs) IL Claims data: all agencies maintain a claims database for billing and FFP purposes CMS 64 Form: to claim FFP for all waiver expenditures and (MH) State Plan Services Managed care expenditures (capitated rates): Healthcare and Family Services (HFS) is working with Milliman, the actuary, to provide required data. IN** Track budgeted and actual costs Monitor quality of care and provider cost savings KY CMS 64 Form Reports An All Claims Payer Data Base is currently being developed. LA** CMS 64 Form Reports CMS 372 Form Reports: to demonstrate that HCBS waiver programs are cost effective and cost neutral, to report state expenditures, and provide pertinent information in order to assess program status MA LTSS Quarterly Reports MD LTSS Maryland tracking system ME LTSS data for accountable care orgs (ACOs) CMS 64 Form Reports CMS 372 Form Reports: to demonstrate that HCBS waivers are cost neutral Quarterly reports detailing information on LTSS Track expenditures by service category Compare services referred and completed over time (within plans of care) National Medicaid HCBS Data: expenditures by service category CMS 64 Form Reports CMS 372 Form Reports MO Track balancing benchmark Track participants accessing community and institutional LTSS 2

3 Claims data Encounter data* Other MS Produce service data reports NH DHHS Provider Payments Report BIP Category Service Report CMS 64 Form Reports Use of data for administrative, financial or quality control purposes NJ Participant Record Review as maintained by care management entities Participant File Summary Review Participant Satisfaction Summary Critical Incident Summary Division of Developmental Disabilities Performance Data Participant Clinical Assessment NV CMS 64 Form Reports NY Cost reports by managed care organizations (MCOs) CMS 37 Form Reports CMS 64 Form Reports Quarterly and Annual Cost Reports Ad hoc reports from data warehouse source Ad hoc reports from encounter data OH National Medicaid HCBS data CMS 64 Form Reports CMS 372 Form Reports PA CMS 64 Form Reports Office of Developmental Programs (ODP) Dashboard for Intellectual Disabilities and Autism HealthChoices Behavioral Health Performance Based Contracting Report TX Demonstrate home and community based services are cost effective and cost neutral Report state expenditures and participation levels Monitor service quality and outcomes for fee for service providers and MCOs Evaluate MCO contract compliance and reporting consistency * Collected from Managed Care Organizations (MCOs) 3

4 Quality Data State Developmental/ Intellectual Disability How are results made available to LTSS providers? AR Youth Outcome Questionnaire (YOQ) Medicaid Adult Health Care Quality Measure Review Checklist Money Follows the Person (MFP) Quality of Life Medicaid Adult Health Care Quality Measure Medicaid Adult Health Care Quality Measure Review Checklist Annual reports are posted on the State Medicaid website. CT measures related to service plan and delivery Metrics on emergency Department utilization, hospital readmissions, and successful ambulatory follow-up post psychiatric hospitalization measures related to service plan and delivery measures related to service plan and delivery CHCPE Provider Audits compares paid claims and services provided measures related to service plan and delivery Results will not be available to LTSS providers. GA Georgia Adult Medicaid Quality Improvement Initiative Georgia Adult Medicaid Quality Improvement Initiative Case management providers will be continually engaged in training and process improvement activities related to the outcome of the work. IA Member survey Provider reviews Service plan reviews Member survey Provider reviews Service plan reviews Member survey Provider reviews Service plan reviews Member survey Provider reviews Service plan reviews The state will engage stakeholders to develop the most effective strategy for releasing the results to the public. IL Health & Quality of Life Performance DD Waiver Performance Community Care Program Quality Management Report Health & Quality of Life Performance The State s External Quality Review Organization (EQRO) Vendor posts Illinois External Quality Review (EQR) Technical Reports on the IL Healthcare & Family 4

5 Developmental/ Intellectual Disability How are results made available to LTSS providers? Report Health & Quality of Life Performance Supportive Living Record Reviews DRS WebCM Report (Home Services Program, AIDS, and BI waivers) Supportive Living Record Reviews Services website. : Providers receive a copy of the Quality Management Report to compare themselves to other providers. Alcohol & Substance Abuse: Provider performance reports are posted online. IN** Provider Compliance Report Reassessment Percentage Report Residential Habilitation and Support (RHS) and Day Services Summaries Comprehensive Error Rate Testing (CERT) Reviews Provider and Person- Centered Compliance Tools Provider and Person- Centered Compliance Tools : Results are posted onto the Division of Aging s website and provided to AAAs and providers. ID/DD: Results are communicated with providers via . MH: Results are discussed with providers. KY Statistics Improvement Programs Youth Services for Families National Core Indicators Dashboard indicators established to monitor the parameters of CareWise, the Quality Improvement Organization Dashboard indicators established to monitor the parameters of CareWise, the Quality Improvement Organization Dashboard indicators established to monitor the parameters of CareWise, the Quality Improvement Organization. Website and one-on-one problem solving with individuals and providers. Dashboards are currently available to internal staff. LA** 1915(i) state plan amendment (SPA) Quality Indicator (QIS) 1915(b) & 1915(c) Performance Waiver QA Healthcare Effectiveness Data and Information Set () : Results are posted on the Office of Aging and Adult Services (OAAS) website ID/DD: The Office for Citizens with Developmental Disabilities (OCDD) will be incorporating quality data on the OCDD public website. MH: Office of Behavioral Health (OBH) provides copies of the Quality Improvement 5

6 Developmental/ Intellectual Disability How are results made available to LTSS providers? Strategy (QIS) results and reports, upon request, to interested parties through print or electronic media or alternative formats for persons with sensory impairments. MA Non-Institutional Provider Review (NIPR) Subset of Medicaid Adult Health Quality NIPR Subset of Medicaid Adult Health Quality NIPR Subset of Medicaid Adult Health Quality NIPR Subset of Medicaid Adult Health Quality Metrics will be posted on the Massachusetts Management Information System (MMIS) MassHealth Provider Online Service Center (POSC) of all MassHealth recipients receiving services and supports across all age groups. MD Quality and Outcome Indicators Developmental Disabilities Administration Quality Assurance Team Review State Medicaid Agency (SMA) Oversight Review Protocol Process Department of Health and Mental Hygiene (DHMH) Quality Care Review (QCR) Report QCR Report The details of the QCR reports are mailed to the providers with information on how to respond to the identified problem areas. ME Medicaid Adult Health Quality The Chartbook Report: Older adults and adults with physician disabilities; populations and service use trends in Maine, is provided annually to the Legislature. MO Medicaid Adult Health Care Quality MS MS is currently reviewing the Medicaid Adult Healthcare Quality to identify potential measures 6

7 Developmental/ Intellectual Disability How are results made available to LTSS providers? NH Medicaid Adult Health Care Quality NJ Global Level of Functioning (GLOF) OPIA, DDL Licensing Inspection System Report Participant File Review Tool Participant File Review Tool The Performance Report is available on the web. Statistical Improvement Program (MHSIP) Consumer Level of Care Index Plan of Care Provider Network Critical Incident Report Complaints, Grievance and Appeals Rebalancing LTSS NJ Substance Abuse Monitoring System (NJ SAMS) Unified Services Transaction Form Day/ Employment Audit Activity Report Quality Provider Report Unusual Incident Reporting System (UIRMS) Medicaid Adult Health Quality CCW/Five Percent Platform Accrediting Bodies Unusual Incident Reports: Division of Developmental Disabilities, Office of Licensing College of Direct Support Utilization Report Participant Satisfaction Level of Care Plan of Care Provider Network Critical Incident Report Complaints, Grievance and Appeals Rebalancing LTSS Accrediting Bodies Participant Satisfaction Level of Care Plan of Care Provider Network Critical Incident Report Complaints, Grievance and Appeals Rebalancing LTSS Accrediting Bodies Unusual Incident Reports: Division of Developmental Disabilities, Office of Licensing Quality Indicators Report Financial Accountability Reporting NV 7

8 Developmental/ Intellectual Disability How are results made available to LTSS providers? Medicaid Adult Health Care Quality NY Phase I Behavioral Health Organizations Metric National Core Indicators (NCIs), personal interview protocol Restrictive Interventions Application (RIA) Incident Report and Management Application (IRMA) Home Care Quality Indicators (HCQIs) generated from UAS- NY assessment data HCQIs Generated from UAS-NY assessment data : HCQI results for all plans are published in the Managed Long Term Care Report, which is made available on a public website. In 2014, HCQI reports can be directly downloaded from the UAS-NY system. / QARR measures are calculated by managed care plans and submitted to the New York State Department of Health (NYS DOH). Health Home Care Management Assessment Reporting Tool (HHCMART) ID/DD: Data can be downloaded from systems or shared in provider-specific reports or summary reports. MH: A data portal is available on the Office of (OMH) website for the Phase I Behavioral Health Organizations metrics. OH Medicaid Adult Health Quality Medicaid Adult Health Quality Ongoing reviews of Medicaid waivers Waiver Performance CHIPRA Medicaid Adult Health Quality Ongoing reviews of Medicaid waivers Waiver Performance Medicaid Adult Health Quality Ongoing reviews of Medicaid waivers Waiver Performance CHIPRA State will follow CMS guidance regarding sharing analytical results and will post results of the Balancing Incentive Program quality indicators on the Medicaid website. PA Program Evaluation Performance Summary (PEPS) Tool Independent Monitoring for Quality (IM4Q) Report Office of Developmental Service Coordination Monitoring Tool CMS 1915(c) waiver Service Coordination Monitoring Tool CMS 1915(c) waiver Office of Developmental Programs (ODP) will share assessment-related information with the community. Reports will be posted to the ODP website and sent out via other means of 8

9 Developmental/ Intellectual Disability How are results made available to LTSS providers? HealthChoices Behavioral Health Performance Tool Programs (ODP) Dashboard for Intellectual Disabilities and Autism Adult Autism Waiver (AAW)/Adult Community Autism Program (ACAP) Participant Interview Guide for Quality Management AAW Provider Agency Monitoring Staff Qualifications Form AAW & ACAP Monitoring Tools CMS 1915(c) waiver assurances assurances assurances communication. Office of & Substance Abuse Services (OMHSAS): Results of Quality Data Reviews are managed and sent out by the Behavioral Health Managed Care Organizations (BH-MCO). Office of Long Term Living (OLTL) will host results from the monitoring tool on the OLTL website, and summaries will be shared at various OLTL Quality Council and Committee Meetings. Bureau of Autism Services (BAS): The results of the AAW quality data will be made available on the BAS website. For the ACAP Waiver, BAS does share a summary report of the program monitoring results with the LTSS Provider. TX Consumer Assessment of Healthcare Providers and Systems () Medicare Health Outcomes (HOS) measures measures Medicare HOS measures Medicare HOS The External Quality Review Organization (EQRO) produces a STAR+PLUS quality of care report and conducts a survey annually. These reports are published on the Health and Human Services Commission (HHSC) website as are any focus studies. 9

10 Outcomes Data State Developmental/ Intellectual Disability AR Division of Behavioral Health Services (DBHS) Community Centers Satisfaction Adult and Child National Core Indicator (NCI) CT GA IA DMHAS Waiver Evaluation Medicaid Member s Integrated Employment Data NCI Aging and Disability Resource Center (ARDC)/Regional Entity Data Participant Experience (PES) Monitoring of Time to Receive Services via Integrated Access PES IL Managed Care Performance Improvement Project (PIP) Division of (DMH) Evaluation of Care Managed Care Consumer Assessment of Health Plan Division of Alcohol and Substance Abuse (DASA): Abstinence from Alcohol/Drug Use of Former Alcohol/Drug Users Managed Care PIP Developmental Disability (DD) Critical Incident Reporting System (pilot phase) NCI Managed Care Consumer Assessment of Health Plan Managed Care PIP Department of Aging Participant Outcomes and Status (POSM) Quality of Life Managed Care Consumer Assessment of Health Plan Managed Care PIP (also individuals with TBI or HIV) Managed Care Consumer Assessment of Health Plan (also individuals with TBI or HIV) IN** Quarterly Outcome Report Medicaid Rehabilitation Option (MRO) Client Data Division of and Addiction (DMHA) Resident Stability NCI Health Home Reports through Division of Disability and Rehabilitative Services (DDRS) 90-Day Checklist Person-Centered Compliance Tool (PCCT) PES (also individuals with TBI) Person-Centered Compliance Tool (PCCT) (also individuals with TBI) 10

11 Developmental/ Intellectual Disability Report PES (also individuals with TBI) KY Statistics Improvement Program (MHSIP) Brief Psychiatric Rating Scale (BPRS) NCI Family s Adapted Quality of Life (HCB waiver) LA** NCI Office of Aging and Adult Services (OAAS) PES MA NCI MD ME MO MS Mental Hygiene Administration: Outcome Measurement System Adult and Well Being Customer Services Postcard Consumer Satisfaction on the MOCOR website Customer Services Postcard Consumer Satisfaction on the MOCOR website Family/Guardian Adult Consumer Adult/Family and Child/Family s ASAP Client Satisfaction Outcomes measures are being built into the new LTSS System as it is being developed. InterRAI HC Quality Indicators Medicaid LTSS Chart Book summarizing demographic, service utilization, acuity, expenditure, and length of stay data LTSS Provider Customer Services Postcard Consumer Satisfaction on the MOCOR website NCI PES NCI InterRAI HC Quality Indicators Medicaid LTSS Chart Book summarizing demographic, service utilization, acuity, expenditure, and length of stay data Customer Services Postcard Consumer Satisfaction on the MOCOR website NH Public Consumer PES 11

12 Developmental/ Intellectual Disability NCI NJ MHSIP consumer survey NJ Substance Abuse Monitoring Level of Care Requirement Index For Addiction Treatment Unified Services Transaction Form for clients entering/leaving mental health treatment Global Level of Functioning NCI Olmstead Review MLTSS Plan of Care Provider Capacity and Capabilities Critical Incident Management System (CIMS) Complaints, Grievances and appeals NJ CHOICE Clinical assessment tool MLTSS Plan of Care Provider Capacity and Capabilities CIMS Complaints, Grievances and appeals NJ CHOICE Clinical assessment tool Case Management Deficiency report MLTSS Plan of Care Provider Capacity and Capabilities CIMS Complaints, Grievances and appeals NV PES Functional Assessment NY interrai Community Assessment (for individuals enrolled in managed care) Behavioral Health Supplemental (for individuals enrolled in managed care) Member Transition (for individuals enrolled in managed care) New York Employment Services System (NYESS) NCI OPWDD Tracking and Billing System (TABS) emedny Medicaid tracking system UAS-NY assessment system (for individuals enrolled in managed care) Member Transition (for individuals enrolled in managed care) OH Statistics Program (MHSIP) NCI 12

13 Developmental/ Intellectual Disability Youth Satisfaction for Families National Outcomes (NOMS) PA PEPS Tool Health Choices Behavioral Health Performance Tool IM4Q Report/Essential Data Elements (EDE) Instrument AAW Participant Interview Guide for Quality Management Service Coordination Monitoring Tool TX Child & Adolescent Texas Recommended Assessment Guidelines Adult Texas Recommended Assessment Guidelines (Adult-TRAG) NCI Child and Family (survey of parents with children receiving LTSS from the Department of Aging and Disability Services) NCI Child and Family (survey of parents with children receiving LTSS from the Department of Aging and Disability Services) NCI Adult HCBS Waiver Study PES ** As of 12/31/2014, state is no longer participating in the Program. 13